Individual
DR. WILSON NICOLAS OTERO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9149 ESTATE THOMAS, PARAGON MEDICAL BUILDING SUITE 208, ST. THOMAS, VI 00802-2615
(340) 714-1122
Mailing address
12400 SW 1ST CT, PLANTATION, FL 33325-2702
(954) 483-8335
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
44063
AZ
207RG0100X
Gastroenterology Physician
3572
VI
207RG0100X
Gastroenterology Physician
44063
AZ
207RG0100X
Gastroenterology Physician
Primary
MD00030353
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020549565
HUMANA HTLH INS ID #
FL
05
—
040931600
—
FL
01
—
1025558
CAREPLUS PROVIDER ID #
FL
01
—
104531
MEMORIAL MANAGED CARE ID
FL
01
—
237645
AVMED PROVIDER ID #
FL
01
—
28885
STAYWELL HLTH PLANS ID #
FL
01
—
33648
NEIGHBORHOOD HTLH PLAN ID
FL
01
—
4073765
AETNA NETWORK ID NUMBER
FL
05
—
582847
—
AZ
01
—
59257
VISTA HEALTH PLAN ID #
FL
01
—
96681
BLUE CROSS BLUE SHIELD FL
FL
Enumeration date
04/30/2007
Last updated
03/28/2023
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